BOOK REVIEWS

This book should have significant interest for many readers of Informal Logic. Recent developments, in particular the 1986 first International Conference on Argumentation in Amsterdam, indicate that scholars from many disciplines are actively investigating argumentation. A significant literature has developed over some years, much of it unfamiliar to North American philosophical audiences. What are the most significant contributions to this literature, who are its central figures, and with which problems in particular do these scholars deal? What work is relevant to what problems? Van Eemeren, Grootendorst, and Kruiger's book is well titled, for it provides a guide to certain major contributions of philosophical interest in this recent literature. It describes their work, while indicating the main issues of argumentation theory and its classical background. The authors begin by presenting their own understanding of argumentation and its theory. According to them, "Argumentation is a social, intellectual, verbal activity serving to justify or refute an opinion, consisting of a constellation of statements and directed towards obtaining the approbation [based on rational assessment] of the audience." (p.?) This not only defines "argumentation" Informal Logic IX.1 Winter 1987

A RECENT French critic, speaking of a new edition of Scarpa's work on Diseases of the Eye, very properly observes of it?te Que ce n'est point de ces editions que la supercberie denos libraires fabrique en recomposant la feuille du titre." Precisely the same remark may be made respecting the new edition of the work before us; for, it is not only enlarged by many useful, and in some points necessary, additions,but is judi* ciously modified, as we are convinced, throughout the greater part of its former arrangement. The author himself, indeed, in the advertisement prefixed to the new edition, states, that he felt bound, in gratitude and duty, from the success of the first impression, in 1819, to render the present one still more worthy of public acceptance, by large additions.
Logic, as one of the moral sciences, has been so much perverted by the schoolmen, that the very name of it excites a smile. Bacon was so convinced of this, that he studiously avoided the very name of logick, and either substituted for it the synonym dialectic, or employed his own quaint peryphrasis <c novum organum." -In undertaking the present work, our author has attempted to restore logic to its original dignity and utility; and, when we consider how important it is to those who are to practise physic, that they should possess the means of disciplining their minds to the right investigation of truth,?the profession will feel obliged to Sir "Gilbert for having endeavoured to extend the art of discriminating good from bad evidence, to a branch ot natural knowledge essentially beset with every species ot fallacy. no. 272. 3 d 386 Critical Analysis, That such is the nature of the obligation we owe to Sir Gilbert Blane, may indeed be collected from his own declared purpose, with which the introduction terminates: " It is the author's intention, with unfeigned diffidence and humility, to endeavour to point out in what medical truth and error corv sist; what are the difficulties that have obstructed the progress of the art, and what are the means of obviating them: in other words, (if he may be allowed to adopt professional technology,) to expound the physiology, pathology, and therapeutics of the medical mind, as the result of fifty years' observation, experience, and meditation, ob these subjects." In the preliminary remarks, the author has entered into a concise metaphysical inquiry into the faculties of the mind employed in ascertaining those truths which depend on correct observation and a right interpretation of the works of nature.
He asserts, in common with some other authors, that the senses may be considered as the types of universal nature ; and he further remarks, that there is a like accordance with the faculties of the mind, particularly that part of the mental constitution by which we are made susceptible of habit and association.
"In tracing this still farther, we perceive that, by virtue of this (correspondence or co.ordinance of the frame of the mind with the established course of nature, there-is, in all the changes produced by the action of external bodies on each other and on our own bodies, a rapid and instinctive connexion between cause and effect, manifested in that part of our constitution by which it is made susceptible of habit and association, and which is indispensable to our well-being, and even our existence, particularly in early life. This may literally, and without a figure of rhetoric, be termed the mental organ; for it carries a reference to the constancy of nature, just as the eye does to the affections of light, and the ear to those of the air. Thus is every organ and function of the body, and every faculty of the mind, co-relative with, or represents and reflects, as it were, not only the elements, but the laws, of universal nature ;* so that the sublime images and glories of the creation are displayed to our sensitive capacities as objects of grandeur and beauty, and to our intellectual capacities and enraptured minds as irresistible evidences of harmony and design."?P. 20?21. In the body of the work, the author sets out with professing to follow the inductive method of investigation, as less liable to error than the syllogistic. This last, however, he does not treat with the same contempt as some other modern metaphysicians; alleging, that it tends " to give precision to language and thought, and to induce habits of close attention and patient ap-logy and pathology. These elementary principles are ten in number:?], The Generative; 2, the Conservative; 3, the Temperative; 4, the Assimilative; b, the Formative; 6, the Restorative ; 7, the Motive ; 8, the Sensitive; 9? the Appetitive; io} the Sympathetic." To follow our author through his detailed illustrations of each of the above principles, would be, in a great measure, to travel over the same ground we did on a former occasion, when we reviewed the first edition. We cannot, however, deny the public and ourselves the pleasure of noticing a few of the many facts and observations, some new, and some more happily demonstrated than heretofore, with which the body of the present edition abounds, and which we find arranged under the different subdivisions that treat of the elementary principles. Thus, under the u generative," there are some curious remarks of the steady proportion of the sexes, in spite of the great inequalities of individual procreation; and, in speaking of the " conseivative" principle, Sir Gilbert remarks, that, though one of the fundamental principles of life, it has been strangely neglected, and even entirely overlooked, by some physiologists'. As for the attempt made by several of them to account for this curious principle by the perpetual motion of the living fluids and solids, the author considers it as futile in the extreme. We have, under the i' temperative" principle, considerable additions of importance, particularly where the author combats those opinions which assign a chemical origin to animal heat. On this subject, Sir Gilbert's remarks are worthy of attention. u The standard of heat is very difierent in different species of animals. In the amphibia and fishes, it is very little above that of the surrounding medium. But the resistance which these animals give 3p2 388 . ' Critical Analysis; . both to heat and cold, by maintaining their specific temperature in spite of the application of higher or lower degrees of it, contrary tp the law of communication in inanimate bodies, is a proof that temperature is both raised and depressed by some power essentially inherent in life. This is most observable in birds; for, in those even of the smallest size, the natural heat is ten or twelve degrees above the human. When it is considered how immeasurably greater the abstracting power of the atmosphere is in these small bodies, in consequence of the ratio of their surface being as the square of their mass, it is utterly impossible to account for this on chemical principles, and must depend on a specific generating power, furnished in various degrees to the respective species of animals; and it must be astonishingly great in small animals, to enable them to resist the strong power of abstraction in the external medium. This argument is rendered still more strong by what is found to take place with regard to some insects. Let the bulb of a thermometer bo thrust into a swarm of bees, the heat indicated will be 97? or 98?, that is, as high as that of the living human body.'*?P. 43?44. We also wish to recommend to our readers a number of other remarks on temperature, physiological, pathological, and practical, with which this part of the work aUpunds, and many of which are new.
It is under the appellation of (t assimilative" principle that the author has grouped the two physiological functions of digestion and secretion. Here Sir Gilbert enters at full length into the changes produceable by the sole power of animal life, as distinguished from the chemistry of dead matter; alleging that, from the similarity of animal matter in all animals, whatever their food may be,?also from the experiments of Allen and Pepys on respiration,?the power of life in producing, or rather creating, new modifications of matter, is far more considerable than has been commonly allowed. Sir Gilbert takes occasion also to advert to the question respecting the influence of the nerves in modifying digestion and temperature, and seems unwilling to admit it in the sense and to the extent of some other physiologists; grounding his opinion, not only on what occurs in animals without brain and nerves and in vegetables, but on a distinction also which should be made between an actuating and an influential, or intervening, cause.
In a book of so much merit, and one which for reasoning power hasseldom been surpassed,we are, of course, anxious that nothing should wear the appearance of wrong induction. An instance, however, of want of rectilineal induction, as it appears to us, occurs under the very head of which we have just given an analysis, and relates to the author's individual opinion regarding the influence of nervous action on the assimilating process. The author alleges, first, that t( nervous power is found, in some instances, even to retard and disturb the assimilating process j" and Sir G. Blane's Elements of Medical togick. 389 lie supports his assertion by the fact that, in many cases of hemiplegia, digestion goes on better than in ordinary health. Now, although we do not mean to deny that either of these premises may be correct, it does not follow that, ergo, where there is no hemiplegia,?or, in other words, where the " nervous power is not withdrawn or impaired,"?nervous action will be found "to retard and disturb the assimilating process;" a conclusion to which the reasoning of the author seems to us inevitably to lead, though, we believe, without the consciousness of the writer. Besides, Sir Gilbert is aware that, where a portion only of any symmetrical arrangement in animal organization has its function suspended, par ure cause quelconque, its power of acting is generally transferred to the agnate portion whose vitality has remained entire. That which would be a much better illustration of Sir Gilbert's proposition, (were the fact true,) and which Sir Gilbert has actually advanced as " a further illustration," on the authority of an article in the 18th Number ol the Journal of the Institution, is the continuation of digestion and chylification after the division of the nerves of the stomach. Unfortunately, such is not really the fact; for, from the repetition of the same experiments which has taken place at the Royal Institution, subsequently to the publication of Sir Gilbert Blane's new edition, we have been taught to believe that digestion and chylification do not go on when the nerves of the stomach are properly divided : that is to say, when a portion is removed from the length of the said nerves, so as to preclude the chances of apposition in the divided ends. Does not the individual "who has had the misfortune of injuring the sacral nerves of both sides, by falling backwards on the sharp edge of a step, lose the power of moving both extremities ? and has it not been remarked, by various writers, that, where the one extremity only has been paralyzed, the other has exhibited signs of evident increase in its temperative, assimilative, motive, and sensitive principles?
There is another doctrine of the author in this part of the work, to which we are not disposed to subscribe. We are the more anxious to mention this, because it relates to practical medicine, the improvement of which must, after all, be the principal object of the author, of ourselves, and the public. Sir Gilbert observes, at page 67, that, (t as fluids are incapable of assuming an organized structure while they retain that form, and therefore incapable either of initiating or giving direction to motion,?all the initial actions of life, as well as its ulterior processes, must be referred to the solids." Now, admitting this proposition to be correct, how does it follow " that the virtues of medicine should, be directed to those attributes that belong to solids; that is, excitability, sen,. 390 V: Critical Analysis. sibility, arid contractibility ?" We confess we are not ourselvek so entirely divested of early prejudices in favour of humoral pathology, as not to see that the solidism of the present day has done nearly as much harm in physic as the former doctrine. Sir Gilbert himself has acknowledged that certain medicines operate on principles purely chemical; and as, in the two examples of this fact adduced by him, fluids alone are concerned in producing the very diseases which are only removed by chemically correcting, neutralizing, or annihilating those fluids, it follows that " sensibility, excitability, and contractibility," are not the onty principles to which the virtues of medicines should be directed. Some people have contended that the "formative," or plastic, principle does not differ from the " assimilative but Sir Gilbert compares the one to an edifice, and, to the materials of which that edifice is composed, the other. The creation and application of these materials to the rearing of the wonderful fabric of the living body, is one of the most astonishing phenomena which the human mind can contemplate. There are some practical remarks, with which this article concludes, respecting the expediency of bleeding in old age,?a period of life in which the author states that less blood is expended in the repair of the body, and is therefore liable to accumulate and produce plethora, requiring evacuation. It is from the cause above mentioned that aged people are frequently subject to spontaneous hemorrhages, which are not only innoxious but salutary.
" I vvas lately called to a lady aged 82, emaciated and wealc, labouring tinder a profuse hemorrhage from the nose, by which nearly a quart of blood was lost. It was followed neither by faintness nor weakness, but by an improvement in health, in point of vigour and alacrity, evidently proving that there was a redundancy of blood, the removal of which gave relief.
Other similar cases have not unfrequently occurred to me. Lately 1 had occasion to know of a female, aged 100, who, in an attack of pneumonia, had been freely and successfully bled in the arm. Sydenham gives very strict cautions against bleeding aged people, without assigning any reasons, and without any exceptions or qualifications ; resting, no doubt, on the plausible notion that, old age being a state of exhaustion and debility, a loss of blood must always be detrimental. This is perhaps true in a majority of cases ; but I am well convinced that practitioners will fall into frequent and fatal errors by adhering to it as an invariable rule." We read with pleasure the new remarks on sleep, contained under the head " restorative principle." They are illustrated by practical observations and anecdotes; nor were we less entertained with what he has written on the subject of the vix tyedicQtrix natura, which is treated at some length.
Sir G. Blane's Elements of Medical Logick.

391
In discussing the next principle, the " motive," or muscular action, in its most extensive sense, Sir Gilbert has introduced some physiological, as well as practical, remarks 011 tension, as a state of the living fibres absolutely necessary for their healthy action. The detrimental, and even fatal, effects of its defect are exemplified in hemorrhage and sudden depletion; while the salutary results of even artificial tension are illustrated byswathing the body and the strapping of ulcers. It is upon the principle of artificial tension, we have a right to presume, that our author has imagined a mode of treating chronic and threatening hydrocephalus by bandages; the good results of which our readers will find illustrated by examples, in the paper addressed to us by the author, and inserted among the Original Communications. Its further advantages (tension) in promoting digestion, are thus developed by the author: <c Nature has wisely provided that, along with the pure nutritious matter of the food, there should be a certain admixture of unassimilable matter, in order to give it more bulk, and thereby more tonic energy to the stomach. The most invigorating articles of food, accordingly, are such as are introduced into the stomach in a solid form, and not only devoid of fluidity, but possessing a certain degree of hardness and tenacity, so as to excite the powers of the containing viscus to stronger action. It is found, therefore, in the human species, that plain solid food, combined with a certain proportion of nnassimilable matter, is infinitely more efficient for the purposes of health and strength, than that which consists of pure alimentary matter, whether gelatinous, albuminous, oily, or saccharine. And, with regard to animals, it is a well ascerlained fact, in horses, that their strength is much better sustained by hay than by grass; for the stomach, being an organ of universal sympathy, does, by the exertions on which it is put in digesting hard food, confer vigour on the whole frame." A verjr important obstetrical question, and new in this edition, will be found treated under this head at full length. We allude to the occurrence of uterine hemorrhage, or flooding, particularly after child-birth. On this subject, Sir Gilbert lays a great stress on the necessity of administering cordials and opium ; and he alludes to five cases which occurred in his own practice, in four of which he made use of that plan of treatment, with the most satisfactory results. With^the usual caution which invariably marks the man of long-tried experience, in advancing these cases, Sir Gilbert does not mean to generalize their mode of treatment: and in this he is perfectly right; for we can assure him, that in our own not very limited practice, in cases of uterine hemorrhage, an indiscriminate use of cordials, or even of opium, "would have frequently given rise to the most fatal consequences. As to the reliance of the author upon cordials in assisting to strength, and health of the various organs, with the consideration of which he concludes the article on the motive principle. We must be indulged in the pleasure of quoting a short extract from our author, on the subject of indolent habits and excess of sleep.
(' The indulgence in indolent habits and excess of sleep in which those ranks of life who do not depend on bodily labour are enabled to indulge, contribute, no doubt, to create those diseases, particularly the gout, which are peculiarly incident to the affluent. During the twelve years in which I was physician to one of the largest hospitals in London, not one case of gout occurred in several thousands which came under my care; an irrefragable proof that, as labour (I ought to say, habitual and unremitting labour), with simple diet, infallibly prevents gout, so its remote cause must be sought for in the reverse of these. Of the manner in which this is brought about,?that is, the proximate cause, I have never seen any rational conjecture, nor am I able to form one myself; but such is the fact. The share which excess of sleep has in creating chronic disease, has probably not been sufficiently attended to, unless we are to except the common popular observation, that all long livers have been early risers. Ought not a superfluous share of sleep to be deemed a debauchery, as much as an excess of food and drink ? If the proximate cause of gout and hypochondria should ever be discovered, it will probably be found in the relation in which defect of muscular action and excess of sleep, combined with a redundancy of aliment and the habitual stimulation of vinous liquors, stand with regard to the symptoms which characterize these maladies." There is nothing very new in the present edition regarding the il sensitive1' principle ; but we have another principle added to the former list, under the appellation of " appetitive." Some curious examples are adduced under this head, of the existence of this principle in vegetables,?such as their instinctive motions in search of light, air, heat, and water.
The last article in the list of vital principles is " sympathy," which, by establishing the mutual influence of every part upon every part, constitutes the unity or individuality of animals. The author alleges, that, though sympathy be carried on, in general, through the instrumentality of the nerves, it is not absolutely nor invariably so ; and this he has illustrated by facts adduced from the economy oi vegetable as well as animal life.
Having thus established an analytical scheme of the principles of healthy life?an alphabet of physiology,?the author thinks he has laid the foundation for the genuine data of theoretical medicine ; since, as he observes, the elements of disease can be expounded only by a thorough knowledge of the elements of life and health. He, however, does not pretend to have effected this with any thing like perfection ; but relies on no. 272. 3 e 394 Critical Analysis, , future investigators for the completion of a system which cannot fail to add dignity to our professional avocations.
The proper object of the present work, however, is introduced in a more particular manner with the second section, wherein the various causes that have most materially obstructed the improvement of medicine are enumerated and elucidated.
The order in which these causes, or sources of error, as the author calls them, are considered, is as follows : " l. The fallacy and danger of hypothetical or theoretical reason. Aug.
ii 3. The difficulty of appreciating the efforts of nature, and of discriminating them from the operations of art. " 4. Superstition. " 5. The ambiguity of language.
physic, or the common business of life, are said in Latin, calhre, whence.callidus ; words derived from callus, that is, a horny substance formed on the hands of mechanical artisans, by long and unremitting labour. Whatever the attainment may be which we aim at, whether mental or manual, nothing but practice will make perfect; there being a certain expertness in the exercises of the mind, as there is a slight of hand in mechanical operations, attainable only by long and assiduous application. This same law of nature is finely illustrated in the following passage from Cicero de Officiis :?Nec medici, nee imperatoreS) nee oratores, quamvis artis prcecepta pcrceperint, quid-, quarn magnce Saudis dignum, sine usu et exercitatione consequi possunt Section the fourth, on the u diversity of constitution," is full of practical matter. The main foundation of this diversity is the artificial circumstance of constitution and habits of life induced on the human subject by the exercise of reason. The principal aim of this part of the work is to throw out cautions against indiscriminate practice. One of his illustrations is taken from Dr. Hamilton's work on Purgatives, which is here praised, but also considerably censured on this score; Sir Gilbert taking occasion, at the same time, to differ from that popular writer on the subject of specific or elective purgatives.
Our limits, however, do not admit of our dilating on this and other practical points discussed with equal felicity under this head.
On the third source of error, the author is considerably more diffuse than in the former edition ; and, in discussing the question on the comparative curability of diseases, we find the following new passage: Sir G. Blanc's Elements of Medical Logick. 397 * \ " For, if "his mind had a bias to scepticism, he mi^ht oil sonic occasions be unable to satisfy himself, in case of a fortunate result, "whether his patient had recovered by virtue of the means employed, ?r in spite of them; and, in case of a fatal result, his feelings would be still more distressing; for what could be more painful to a conscientious and sensitive mind, than the uncertainty whether the loss of the patient was most imputable to the remedy or to the disease. If, on the other hand, he should be prone to credulity, he might be so. far blinded as, bona fide, to plume himself, and to congratulate his patient on a great cure, in what may have only been a great escape The section on lt superstition" is full of classical and historical allusions, and will, perhaps, prove the most interesting to those who read for mere amusement; though this amusement niust be considerably abated by the humiliating picture of the imbecility of the human mind, as exemplified in the history of fatalism, witchcraft, incantations, and quackery.
The article on " ambiguity of language," as a source of error in medicine, is very instructive. Of the many exemplifications of this error brought forward by Sir Gilbert, we shall only select that of <? scurvy," a term applied to certain cutaneous affections, and also to the ,c sea-scurvy," a disease having nothing in common with the other. BoerhaaVe himself confounded them so effectually as to cause four hundred patients labouring under sea-scurvy to be treated with mercurial frictions; all of whom perished.
In adverting to the controversies respecting the yellow-fever, the author alleges that they have arisen chiefly from an ambiguity of language; on the grounds that, although the diagnostic characters of this disease are to be found in that form of it which arises from endemic exhalations and in the sporadic form, there is occasionally, superadded to these, a typhoid cause, which renders it contagious. The whole article on yellow-fever is considerably curtailed in the present edition, without losing any of that importance which the pen of our author knows how to impart to subjects of such moment.
The last source of error enumerated is the " fallacy of testimony." The reader need not be told how deceitful is the mind of man, which does not even know its own motives, and, from education, early prejudices, or self-interest, embraces the most glaring absurdities and falsehoods as truth. It is, therefore, entirely in the spirit of such a work as the one before us to advert to the errors which have arisen from the intentional, but still more from the w7zintentional, mis-statements of matters of fact by writers. Sir Gilbert's illustrations on this head are also taken from practical subjects, among which is introduced the history of colchicum as a cure of gout, and a reflection on the advantage of scientific knowledge, if correctly recorded.
We have omitted, in our account of this useful work, any notice of the many moral and philosophical allusions and illustrations, as they relate to general science ; but shall give the reader a specimen of them, by transcribing the two last pages of the author's conclusion. " From the picture that has been exhibited of the innumerable doubts and difficulties which clog the attainment of medical knowledge, and embarrass the application of it to practical purposes, the timid, sceptical, and indolent, may be discouraged from studies apparently so arduous in their prosecution, and so questionable as to the efficiency and utility of their result. But it is not from characters of this description that any good can be expected in any of the useful arts of life. If a like despondency were to pervade mankind in general, there ?would be an end to all that enterprizc and energy which alone can enable them to act up to their destiny, and follow up those pursuits upon which the perfection of their nature depends. As the senses would have lain dormant for ever had there been no external objects to stimulate them, so the faculties and virtue which characterize rational nature and civilized life could never have been developed, but through the excitement of those pains, wants, difficulties, and dangers, inseparable from human life. By no other arrangement could our duties, our happiness, our mental and bodily perfections, have been bound together in one harmonious and consistent system. Let us compare the art of medicine, under this aspect, with those of navigation and agriculture. Had man been furnished by the Creator with wings, by which he could have traversed all seas and oceans, so as to supersede the use of ships, where would have been that hardihood of character, and all those ingenious devices which have called forth the active energies and deep researches of the human mind? if, contrary to the actual institutions of Providence, the life of man had been sustained by the spontaneous productions of nature, instead of the products of industry,, neither the faculties of the mind nor the powers of the body could ever have been developed : man would have been little superior to the brutis; his active and inventive energies would have lain asleep for ever ; there would have been no room for the talents exercised in the procuring of food, raiment, and shelter, nor in commercial intercourse j all the mutual and endearing tics and dependences of social and civilized life, all trades, professions, arts, and sciences, "whether ministering to accommodation or elegance, constituting man's greatest felicity, whether as objects of pursuit or enjoyment, would have been unknown and untasted. " It is obvious that this reasoning, being founded on a general law of nature, must apply equally to medicine. In a probationary existence, it was necessary that man should be tried, not only by pain and sickness, but by the difficulties of remedying them, as exercises of virtue and ingenuity. Why should the road to medical relief lie through fewer and slighter struggles and dangers, than those of navigation and agriculture? But the subject is more concisely and emphatically illustrated by the philosophical poet, than by any amplitude The bibliology of scrofulous diseases is now nearly as extensive as that of consumption and stomach complaints; and, although the author before us asserts that ee the disease [scrofula] has never yet been subjected to any particular and scientific investigation,"* he must mean within the circle of his own knowledge ; for there is scarcely another complaint of the chronic kind that has had mure monographers than the one he has undertaken to write upon. Without mentioning Hamilton's Observations on Scrofulous Affections; Nisbet's Inquiry into the History, Kc. of Scrofula; Beddoes* Essay on Scrofula, in his Hygeta; Carmichael's Essay on the Nature and Cure of Scrofula,-Russell's Treatise on Scrofula; Goodlad's Essay on the Absoibent System, and many more, one or two of which are named and quoted by Mr. Lloyd himself; we would wish to remind him of the numerous publications ?n the same subject which have appeared in other parts, of Europe, particularly of those of Weber, Hufeland, Hitter, l^ujol, Capelle, Hebreard, Baumes; all of which writers have treated the subject of scrofula in " a particular and scientific" manner within the last twenty years. We are not, however, sorry to see another labourer in this vast field of inquiry; and, when the ample opportunities which Mr. Lloyd has enjoyed of conducting a fresh investigation into the nature and causes of scrofula are taken into consideration, few there will be. who will not be disposed to welcome a professed work on that subject from his pen.
il I have had frequent opportunities of examining by dissection the morbid parts, when they have been separated from the body by operation, as well as the bodies of those who have fallen a victim to the * Introduction, pp. 1?2.
disease. I have also had, for many years, under my inspection patients labouring under this disease in all its various forms, and in many cases have been so fortunate as to be able to trace them from their commencement to their termination." The public must not, however, be hurried away, in their judgment on the merits of the present performance, by the mere consideration of those favourable circumstances in which the author was placed, and which lie has detailed in the above extract; nor by the more honourable fact, that Mr. Lloyd obtained the Jacksonian prize from the Royal College of Surgeons for the substance of this very essay. It is the mode in which an individual has availed himself of any advantageous opportunities he may have had for the promotion of science, and not the opportunities themselves, by which we should decide of his claims to public approbation ; and, as to the reward he has already received at the hands of a most respectable body of medical men, we cannot forget that a similar one was awarded to another essay (Mr. Goodlad's,) some years before, in which the subject of scrofula had been treated on different principles ; nor can we attach much importance to these sort of academical distinctions, when we reflect that another body corporate, of as great respectability as the College of Surgeons, once proposed the following question on the subject under consideration : " An strumce vel scrofula' hoc etiam seculo, curari possint solo attactu region Gallice et A ngliee V We shall now proceed to give as clear an account of Mr. Lloyd's performance as we can, offering from time to time such critical remarks as the subject-matter may suggest, in the same spirit in which the author himself has declared that he has spoken of the opinions" of others,?<c without any intention to give offence; and trusting, therefore, that none will be taken at the free expression of our opinion."* The work is inscribed to Mr. Abernethy, whose great and constant kindness to the author, while a pupil in St. Bartholomew's Hospital, naturally called forth this token of gratitude. In the Prefaee, we are informed that one of the objects of Mr.
Lloyd's was to make the principles of Mr. Abernethy, on which the treatment for scrofula is founded, better understood by those out of the profession ; and that the great aim of the work is " to show that scrofulous diseases are, in general, to be removed by attention to the general health of the patient; and that the disease itself is to be considered the secondary, not the primary, object of attention." Mr. Lloyd's book is divided into two parts. The first, extending to forty-eight pages, contains the author's general views on scrofula ; its character and symptoms ; its causes and treatment.
The second part takes a wider range, and embraces considerations, practical as well as doctrinal, on local affections, the effect of scrofula.
I. C/iaracters and Symptoms of Scrofula.?Authors in general, Mr. Lloyd thinks, have fallen into the error of describing tbe state of a patient labouring under scrofula, after the disease had given local evidence of its existence; for they enumerate among the symptoms of a scrofulous diathesis, or which only denote a tendency to scrofula, " a thickened, chapped upper lip; tu? mescence and redness of the tarsi, with weakness of the eyes in general; tumid belly; and enlargement of the lymphatic glands, particularly those of the neck." They ought, on the contrary, says Mr. Lloj'd, to have informed us of the temperament or habit of body of the patient antecedent to the existence of any decisive evidence of the disease. We had therefore expected, in the book before us, a different description from that of any other author,?such a description as would enable us to become acquainted " with the nature of the disease in its first and earliest stage; to anticipate its march; and.to prevent it, by every possible means, from obtaining a ' local habitation' in the body of any individual." In this expectation we were, however, dis.
appointed; for, when we came to read that part of Mr. Lloyd's book which he considers as giving an account of the symptoms " indicative only of a disposition," we found it to embrace, more or less, the same symptoms mentioned by the authors he condemns; symptoms which do not describe a forth-coming disease, but a disease already settled and developed, as our readers will see from a perusal of the following extract: " Scrofula oftcner affects children than persons of any other age, though no age is altogether exempt from it. It appears, however, that thus, in children, the upper lip, eyes, glands of the neck, and those of the mesentery, are generally the parts first affected; the lungs, bones, and other parts, being subsequently attacked. It happens sometimes, too, in children, that small lumps form under the skin in various parts of the body, which suppurate, ulcerate, and pursue tho same course with scrofulous abscesses in general. . These we consider as scrofulous, from the nature of tho matter they contain, and from their co-existing with other affections evidefitly of this description, and from other circumstances which will be mentioned in their proper -.place." If we comprehend rightly Mr. Lloyd's meaning, it comes to this?that, if a child or an adult, enjoying an apparently perfect health, having neither <? small lumps" under the skin, nor " a species of warts" about the face and neck, nor thick lips, nor a thick nose, nor an enlargement of the lymphatic glands, nor a tumescence and redness of the tarsi, nor a tumid belly, be presented to him, he (Mr. Lloyd) will be able to tell whether such a child or adult is likely to be affected by scrofula: " and will anticipate it.s march, and prevent it from obtaining a local habitationThat the author himself may be able to eftect this, we are by no means disposed to doubt; but, that he has imparted to us the same faculty by his description, is what we are not prepared to admit. Let the reader judge. " The appearance of the countenance is really that of delicacy and laugour; though, to the common observer, from the fulness, the peculiar smoothness, and the beautiful colour of the cheeks, it is often that of the highest and most complete health. If, however, it be attentively observed, it will be found that the cheeks, though full and tumid, are softer and more flaccid'than is natural to health; and (hat, instead of being fixed and firm, they hang as it were loose on the face. There are, nevertheless, persons who have the greatest tendency to scrofula, in whom none of these apparent signs of health exist," [and he should say, where these apparent signs exist, who never afterwards exhibit symptoms of scrofula,] "but whose complexions are peculiarly dull and pallid; in these, the appearance of delicacy and langour is even greater than in the former. In the former state, the lips generally partake of the fulness of the face, and are of a beautiful red; while in the latter they are pale. It often happens, too, that the parts about the mouth are of a peculiar dull pallid hue. There is also a remarkable appearance about the eyes, which cannot be accurately described; but the conjunctiva is particularly free from blood-vessels, the pupil is generally much dilated, and the upper eye-lid drops more than natural; to which, perhaps, as well as to the delicate state of habit, the dilatation of the pupil may be in some measure owing." With regard to the distinction commonly made between children of fair complexion and light hair and eyes, as more liable to scrofula, and those of quite a different external charac-tcr, our author contends that it is not founded on legitimate grounds. The extensive investigation he has given to this subject, and his opportunities of examining numerous children ?Every day's experience convinces *r* Lloyd that the local diseases called scrofulous arise from something wrong in the general health, sometimes co-existent with birth, and at other times entirely produced by improper attention to diet, to the alimentary viscera, and other occasional ?r accidental causes. This is intelligible as far as cause and effect; not so with regard to the modus operandi of the cause producing the effect. We confess we cannot look upon the explanation offered by the author as at all convincing, namely, that certain derangement of the vital functions, capable of being produced by a variety of causes, may effect such an alteration in the natural actions of a part, as to impair its functions, and give rise to that change of structure which we term a scrofulous disease." Were it so, how comes it that every deranged stomach does not give rise to scrofula ? Mr. Lloyd may argue, that the deranged stomach must " affect an alteration in the natural actions ?Ja party so as to impair its functions, ere it can give rise to a scrofulous diseasebut, in that case, it will be incumbent upon him to demonstrate how such an alteration in the natural unions of a part as he alludes to, is brought about; and what sort ?f deterioration of its functions must that be which will give rise to scrofula rather than to any other disease. Until he have done his, the doctrine of scrofulous diseases is just where it was, before either Mr. Lloyd or Dr. Carmichael applied Mr. Abernethy's principles as a formula for solving this complicated equation. We know that the majority of our readers will side with us when we advance, that, in merely stating that A (the stomach,) produces an alteration in the natural actions, and Jmpairs the functions, of B (another part of the body,) and gives rise to a subsequent effect (scrofula,) Mr. Lloyd has not thrown a clearer light on the etiology of that disease, than the /<uviorists have done, with their virus,?the cliemio-physicians, with their degenerated fluids, their alkaline and their acid principles,?or the vitalists, wilh their vascular debility. * Lloyd, in illustration of his position, that disorder of the digestive organs is capable of deranging the whole system, 3F2 404 , Critical Analysis, relates several curious cases of patients, who were recovering from various complaints, when, by an accidental derangement of the stomach, a stop was put to the progress of their recovery; and, among others, he tells us of one unfortunate patient, who forfeited his life in consequence of eating a large plum-pudding: but he has not related a single instance in which the eating of a plum-pudding has deranged the stomach so as to alter the natural actions of a distinct part of the body,, impair its functions? and produce scrof ula ; yet nothing short of such a demonstration can be admitted, before we adopt Mr. Lloyd's etiology.
We, therefore, consider this part of the history of scrofulous diseases not to have benefitted by our author's publication.
III. Treatment of the Disease.?If we adopt the theoretical views of Mr. Lloyd as to the nature of scrofula, it follows that, " in the prevention and cure of the disease, our attention must be principally directed to the digestive organ : in the prevention, by avoiding all those causes which tend to disturb their functions; and in the cure, by tranquillizing irritation, and by restoring their healthy actions." The means of prevention consist in warm clothing, the selection of a favourable climate, an appropriate diet, and a careful evitation of baneful passions of the mind, &c.
We select the following case, to prove the benefit which may be derived from warm clothing in the prevention of this disease.
to know at oncc what medicine will be applicable to each particular case.
Indeed, every one must have observed that the same medicine may act very differently on children of even the same age; and that ivhat purges one violently will have no effect on another. We should, too, be very careful not to give violent purges; and we should particularly avoid large purgative doses of calomel, as T am convinced they often produce more general irritation than the evacuation they occasion from the bowels is able to relieve; and that they often so much weaken the stomach, that it is a very long time before it is able to recover its natural powers. Our object, therefore, in prescribing medicines, should be to procurc a proper emptying of the bowels daily, and a healthy condition of the dejections. This, I admit, is often a difficult point to obtain, but by proper management we may generally succeed. Any of the mild purgative medicines may be employed for this purpose, and, if one does not appear to have the proper effect, we should desist from its use, and substitute another; but we may derive the greatest assistance from exhibiting alterative doses of calomel at the same time. The dose should be varied from half to one grain, according to the age and habit of the child, and repeated twice or thrice a-week. Sometimes, in particular states of the stomach and bowels, it is better to combine the calomel with the purgative, and at other times they act better given separately. The very great influence Avhich evacuations from the bowels have over the rest of the body, cannot be denied by any impartial observer: it is, therefore, certain that, by increasing or diminishing them, we are able to produce a decided effect on the whole, or, as I have proved before, on a particular part of the body. Thus, if there is much general irritation, or local irritation and inflammation, by increasing the intestinal evacuation, taking care however not to irritate the bowels, we may very much relieve both the one and the other. The importance, therefore, of attention to the state of the bowels is obvious." Small closes of soda should be exhibited when a great degree of acidity prevails in the stomach ; else, by remaining there, or passing into the bowels, it may do mischief. When there is a weak stomach, with loss of appetite, cinchona, steel, and the mineral acid's, will be found of the greatest service. Of cold sea-bathing, Mr. Lloyd has no good opinion. He has seen it fail in removing the complaint in almost all its various forms; nor does he know a single instance in which he could fairly saythat it had removed it. It may be useful in checking a disposition to the disease.; but it certainly has no power of discussing scrofulous humours, or of healing scrofulous ulcers.
With regard to a residence at the sea-side, Mr. Lloyd insists on scrofulous patients not remaining longer than four, or at most five, months ; though the wherefore is not apparent, since he immediately adds, " that generally he does not believe there is any material benefit to be derived by sending them there." Good air and exercise are conducive to the cure of this dis-ease: the warm sea-bathing Mr. Lloyd thinks injurious to the general health.
Of the inefficacy of sea-bathing in the cure of scrofulous diseases of the spine, hip, or knees, Mr. Lloyd saw a corroborating example, of recent occurrence, which he relates not quite in the spirit of charitable forbearance towards a fellow practitioner.
. " It is the case of a little boy who had disease of the right hip-.J?mt, and about whom I was consulted a little more than two years ago. At this time I made an issue behind the great trochanter, and ?kept the child lying down, and the case went on as favourably as possible. A few weeks after, however, I was taken ill, and therefore unable to attend the case. Another surgeon was therefore consulted, and he at once recommended that the child should be sent to the seaside; which was immediately done, and he continued there till very lately. Since his return, I have seen him ; and I certainly never saw a much more horrible state of deformity, or a case more fully proving the inutility of sea-bathing in these diseases. The spine is much curved; the right hip forms an immense projection ; the thigh is dislocated, and much bent on the body; the knee contracted, and the leg bent on the thigh, and the limb so much shortened that, with the foot bent downwards, the toe will only just reach the ground; and, what is still worse than all, the disease is still going on. Now, I am fully convinced that the whole of this deformity, except perhaps a trilling shortening of the limb, is entirely owing to improper treatment, to ^ant of rest, and to the body not being kept in a proper position, -t his child, however, must remain a complete cripple, and an object of P'ty, as long as he lives. I believe, however, that the disease may now be put a stop to, and some part of the deformity removed." Mr. Lloyd terminates the first part of his book with the following conclusions, fairly drawn (as he says) from his foregoing observations; upon which we forbear making any remark. " First. That scrofula is hereditary, but that the tendency to it may exist without its being called into action. " Secondly. That a disposition to it may be acquired where there is no hereditary tendency. " Thirdly. That all those causes which tend to derange the natural actions of the body are capable of inducing scrofula, and that it always is a constitutional disease,?that is, never depending upon local causes only.
. " Fourthly. That the disease may generally Jje prevented, by avoiding all those causes which have a direct influence in disturbing the general health. " And fifthly. That the disease is only to be cured by avoiding all sources of irritation, and by restoring the natural and healthy functions of the digestive organs." The second part of Mr. Lloyd's book treats, as we have already observed, of the local effects induced by scrofula. There 3 403 ' ?' Critical Analysis. is no structure, nor particular part of the body, which may not be attacked by scrofulous diseases, though some parts are more obnoxious to it than others. Those of which the author treats in detail are the following.
I. Scrofulous Affections of the lymphatic and some other Glands. ?A scrofulous gland, in an early stage of the disease, is simply enlarged. If the disease is not put a stop to, the whole structure of the gland becomes altered and destroyed, and new matter is gradually deposited. At other times, the gland is converted into a much softer matter, and, when cut into, appears to be composed of two kinds of substance,?the one resembling curd, and the other being softer, less opaque, and of a yellow colour. Inflammation of the surrounding parts comes on after a time; suppuration follows, and ulceration in one or more places occur. The gland, however, Mr. Lloyd contends, is not included in the suppuration ; and the abscesses formed around it are known fo be scrofulous from the matter which they contain, which is a wheyish fluid mixed with a curd-like matter, with an occasional appearance 01 what seems to be tolerably good pus.
Several glands often enlarge at the same time, and continue distinct till they have each acquired a very large size; but, at length coalescing, form one immense tumor, which sometimes presses so on one side of the larynx and pharynx as to impede respiration and deglutition. These tumors, even when they have obtained this size, may subside entirely without the formation of matter; of which fact Mr. Lloyd gives the following example: " The first is the case of a young man, a patient in St. Bartholomew's Hospital, aged twenty-one years, who had several glands of the right side of his neck,enlarged for above two years, without their producing much inconvenience; but, his health becoming very much deranged, they increased in size, coalesced, and formed a large tumor, in which there was no fluctuation, which produced great difficulty of breathing and of deglutition, and was attended by violent head-aches. By attending to his general health in the manner that has been recommended, by applying six leeches twice, and a bread and water poultice night and morning, the tumor diminished at least two-thirds in the space of ten weeks; and subsequently entirely disappeared." Besides the lymphatic glands of the neck, there are those of other parts of the body that are liable to be affected. <c It is very common to have a gland enlarge, and form an abscess about the middle of the tibia; just behind the inner cpndyle of the femur; also just above the inner condyle of the humerus; on the in-Side of the ulna, near the olecranon; and above the middle of that bone: above the clavicle, too, is not an uncommon situation. The glands of the groin are frequently affjeted." Mr. Lloyd on Scrofula. 409 Scrofulous abscesses will sometimes form in the parotid glands. The author relates the case of a young woman who had a scrofulous abscess in her right parotid gland, and who eventually recovered. The thyroid us well as the prostate gland are occasionally the seat of scrofulous abscesses ; and, in tact, abscesses of a similar nature may form in every part of the body, independently of the glands. Mr. Lloyd thinks that, in this case, they suppurate more quickly, and that not unfrequently the fluid will entirely disappear. Our own experience does not warrant the above conclusions. Among other cases of the kind last mentioned, we recollect attending one with Mr. Brodie,?a child of a lady of rank,?where the swelling, situated on the centre of the curve of the fourth and fifth ribs, remained of the same size, and with the same degree of tension and fluctuation, for several weeks, notwithstanding repeated applications, intended to discuss in the first instance, and next to promote suppuration. In this case, the muriate of barytes, the blue pill, and afterwards bark, played a conspicuous part in restoring to health the general constitution. The abscess was eventually opened.
We were rather surprised, after reading so much about the simplicity of Mr. Lloyd's views respecting the etiology of scrofula, to find him employing, in this part of his book, a language like this,?that " the uniformity of the effects of scrofula fully proves its title to be termed a specific disease, and its ^ction to be an action sui generis, the peculiar nature of which it would be idle and absurd to discuss." Thus has Mr. Lloyd been reduced to use the identical language of his predecessors, all of whom he indiscriminately condemns for that, without "which he himself cannot explain the nature and mode of action ?f the disease he has undertaken to descant upon. Yet, because Mr. Goodlad has not chosen to call in the aid of this something having an action sui generis, to explain the phenomena of scrofulous disorders, our author, who ought to have commended him for his approach to simplicity, finds fault with him for it; nay, accuses him downright of nCver having cultivated morbid anatomy. We really cannot comprehend so much apparent contradiction.
Treatment.?The less that is done locally to the glands, when simply enlarged and in an indolent state, the better. Proper constitutional remedies should be had recourse to. The part niay be bathed with salt and water. In the more advanced stages, irritation must be allayed by soothing applications, and by leeches and warm emollient poultices. Mr. Lloyd gives a proper indication for the application of blisters ; but, "with regard to opening a scrofulous abscess, he states that no definite rule can be laid down.
<c When any accidental occurrence, as a blow, or the health becoming suddenly much disturbed, excites those parts which had been for a long time in an indolent state to a state of active inflammation, and matter suddenly forms, producing tension and pain ; or if the abscess be situated in the vicinity of a bone, as the tibia or ulna, it undoubtedly should be opened as soon as possible. But, if none of these circumstances occur, if there be neither tension nor pain, although the whole skin covering the abscess be discoloured, and the fluctuation be evident and distinct, and the whole tumor reduced to a state of softness and flaccidity, I believe it is of very little consequence whether a puncture be made or not," II.<?Scrofulous Ulcers.?" The only characteristics of a scrofulous ulcer, that can be depended on, are its occurring after a scrofulous abscess, the peculiar dull red or purple colour of its edges, its remaining indolent for a great length of time, neither increasing nor diminishing in size, and its being attended by the peculiar state of health which has been already described." " I know of no specific remedy for a scrofulous ulcer; nor can we rationally hope to find one for any local disease depending upon a peculiar state of the general health." " Of all the variety of local applications, I know of none that agree with scrofulous ulcers better than those that arc slightly astringent; and what is called the diluted citron ointment is, in my opinion, the best. Under certain circumstances, it may be combined with a small proportion of the ceratum resinae, or of the ungt. zinci. Sometimes, however, the different preparations of lead, and indeed all other local applications, appear to be useful; while in other cases they evidently produce no effect at all."

411
We shall only quote a case in illustration. " A young woman, aged twenty, had a small hard lump formed in the under part of her breast, which gradually enlarged till it was lost in the surrounding parts; became painful, inflamed, and formed an abscess, which discharged about three ounces of a scrofulous matter.
A small ulcer was left: and the parts, which were covered with a bread and water poultice, became in a quiet state. Her health had been for many months in an indifferent state, and her catamenia were suppressed. The constitutional treatment that was adopted consisted principally in keeping her bowels open, and in attention to her diet. 412 Critical Analysis, lous nature, and that the generality of them are certainly curable. He therefore dees not advocate the practice of castration, notwithstanding the high authority of Pott. Among the numerous cases of diseased testicles which occurred in Mr.
Abernethy's practice, during the author's long and active attendance at St. Bartholomew's Hospital, only one required castration ; and that was a case of fungus haimatodes. The epidermis is sometimes affected with scrofula, without the testicle partaking in the slightest degree of the disease. Mr. Abernethy possesses a preparation of this modification of the disease.
V. Scrofulous Affection of the Prostate Gland.?Mr. Lloyd has not met with any instance of the prostate gland converted into scrofulous matter, but has seen repeatedly cases of tleshy enlargement of that gland. They occurred generally in young men of a scrofulous habit. " These cases generally get well by tranquillizing the constitutional disturbance, and by making use of soothing local applications. A bougie should also be occasionally passed, even though there should be no stricture at the time; as, from the state of the prostate and the high degree of irritation in the urethra, there will always be a great disposition to form stricture, which the bougie will prevent, as well as tend to diminish the particular irritation in the urethra, and in the prostate itself. It v.iil also, more effectually than any other means, remove that most troublesome symptom, the frequent desire of making water, which so often attends this complaint. The too frequent introduction of bougies, however, is undoubtedly injurious. Suppositories of opium and other medicines have been recommended to remove spasm and irritation from the neck of the bladder, and in common cases, 1 believe, they sometimes do good; but, when the irritation depends upon a diseased state of the prostate, particularly of the description now under consideration, I should never advise their use.
I have frequently tried them in these cases, and I have oftener seen them aggravate than allay irritation. I never either have seen any of that class of medicines called discutients have the slightest ciFect in reducing this enlargement of the prostate gland; but, as I have stated before, it will generally subside if the state of the constitution be improved, and if no other means be made use of locally but those which relieve irritation." The author next notices the scrofulous abscesses of the prostate gland, and the circumstance of the matter contained within them making its way into the cavity of the bladder. He also states, to have seen the vesicular seminales affected with scrofula, and filled with a cheesy matter.
VI.?Scr<fulous Affections of the Bones and Joints.?The description, as also the details of the treatment, of this modification of scrofula, form by far the best, as well as the most useful, part of Mr. Lloyd's book. They deserve unqualified Mi*. Lloyd on Scrofula. 413 ' commendation, and we crave our readers' earnest attention to them. There is much of practical and experimental wisdom in this subdivision of the work, which stamps it at once as a classical book.
VIII. Scrofulous Disease of the Hip-joint.?The progress of scrofula, and the alteration which it occasions in the structure of the hip-joint, so much resemble what occurs in other joints under the same circumstances, that Mr. Lloyd thinks it unnecessary to extend far his observations on this part of the subject.
Scrofulous disease in the hip-joint, as in all the other joints, comes on so gradually and insidiously, that it is scarcely possible to discover it till the morbid alteration of the bone has gone on to a considerable extent. The first indications that we have of this disease, if we except the disorder of the general health, are, that the patient is a littlelame, and walks on his toe, and that he complains of being tired much sooner than he would if he were in health. This state will often exist for several months without the patient feeling pain ; but at length the lameness increases, and the affected limb is never carried so far forward, in progression as the opposite one, arid shooting pains are occasionally felt in the joint and other parts of the limb. Upon examination, the muscles of the thigh and nates of the affected side are found wasted ; and, as the disease advances, the wasting of the muscles increases, and the limb becomes evidently smaller than the opposite one, and the nates of that side appear widened and flattened. If pressure be now made ?ver the joint, behind the great trochanter or in the groin, it occasions pain, and th'e bone about the trochanter often feels as if it were thickened and enlarged." It is not uncommon for the glands of the groin to take on the scrofulous action, to enlarge, and suppurate, as one of the first symptoms of the joint of the hip being diseased.
Treatment.?The constitutional treatment of scrofulous disease of the hip-joint, of course, differs in no respect from that recommended in all other scrofulous diseases. In the local treatment, on the contrary, there are certain minutise to be attended to, arising from the nature of the part affected. tc Directly it is ascertained that the hip-joint is diseased, it is always ?absolutely necessary to strictly enjoin the most perfect rest, as, without attention to this point, all the remedies we may employ will generally fail in arresting the progress of the disease. As, too, in all the varieties of hip disease, there is invariably a great disposition in the thigh to become bent upon the body; in the leg, to become bent upon the thigh ; and in the spine, to becomc awry ; a mere state of rest is not all that is requisite, but it is also important that we attend to the position of our patient. The patient, therefore, should not only be constantly confined to bed, but should also lie in an horizontal Position ; the lower extremities should be kept constantly straight, a?d the trunk of the body should not be allowed to incline cither to 4t1 4 Critical Analysis.' one side or to the other> so that the heels shall be as near as possible in the same line." , Rest will do much to prevent irritation. The abstraction of blood from the part, by cupping or leeches, does not appear to the author to be attended with much, if any, good in disease of the hip. The early use of counter-irritants, Mr. Lloyd has not recommended in scrofulous diseases of the other joints, because they seem rattier to increase the swelling of the parts, and consequently to promote the formation of abscesses. In the disease of the hip-joint, however, their early use is highly serviceable, Mr. Lloyd mentions this as a fact, and not with reference to any particular theory. The various modes of making counter-^rritation, such as the actual cautery, moxa, issues, setons, scarification, perpetual blisters, tartar-emetic ointment, &c. are next considered, though superficially.
The author states, that, if the plan of treatment recommended in the preceding pages be adopted from an early period of the disease, and the vital organs are as yet sound, he feels no doubt about the successful termination of the case.
Two cases of this disease, which proved fatal, with an appearance of the parts on dissection, we shall quote, as highly instructive.
"The first is the case of a poor boy, aged fourteen, who died of diseased hip, which had existed for nearly four years. The femur had become dislocated, and the limb much shortened; and abscesses had repeatedly formed in the joint, or in the parts surrounding it. At the time of his death, he was suffering from severe cough and profuse expectoration of matter. His abdomen was very large; and he had troublesome diarrhoea, which had continued for above a month. He had also a confirmed hectic.
"Upon examining the hip after his death, the whole joint was in Such a confused mass of disease, that it was impossible to say in what part it commenced : however, upon examining the knee-joint, some clue was given to the nature of the disease. In this joint, the bones were much softened, and the cancelli tilled with a cheesy matter. The cartilages were entire, but there was about half an ounce of synovia in the cavity of the joint. The soft parts were in a healthy state. Upon examining the abdomen, there were found nearly four quarts of serous fluid collected in its cavity ; and the mesenteric glands were most extensively diseased, some being converted into a cheesy substance, while abscesses had formed in the place of others. Upon examining the lungs, they were found tubcrculated, and vomicae had formed in different parts of the right lung.
"The next case is very similar to the former. A poor boy, aged seventeen, died in May 1818, of hip disease, which had existed for nearly three years. The pain which had accompanied it had never been very severe. The bead of the femur had become displaced, the limb was shortened, and abscesses had formed all round the joint, and Mr. Lloyd on Scrofula. 415 left sinuses wherever they had burst. Several glands of the groin had also suppurated, and left scrofulous ulcers. At the time of his death; he had a great difficulty in breathing and a troublesome cough, though without much expectoration. " Upon dissection, the head of the femur was found in great part destroyed, but what remained was resting on the dorsum of the ilium, which at that part was slightly carious. The acetabulum was full of 'j'tnph and pus, and the cartilages, at its edges, slightly eroded. The trochanter major was in part so soft you might easily cut through it, while the neck of the bone was hard and unaltered in structure# The lungs were tuberculated, and in the right lung therewere two large abscesses containing complete scrofulous matter, mixed with a very little blood. The "mesenteric glands were many of them much enlarged, and some of them partly converted into a cheese-like matter." Virr. Scrofulous Disease of the Spine.? This is another very important subdivision of the work before us. I he subject lias lately attracted so much of the attention of the public and the profession at large, that our readers must feel anxious to leain the author's opinion on so interesting a subject. We cannot, however, in justice to Mr. Lloyd, do more than invite our readers to consult the book itself) for we apprehend we have already analyzed and extracted fully as much as a due consideration of the author's interest would admit, and to go beyond it Blight savour of dishonesty. Mr. Lloyd considers the scrofulous disease of the spine under the heads of " angular curvature" and " lateral curvature." The symptoms produced by each sort of curvature are minutely detailed; and next, the individual treatment of each, 1 here is also an account of the symptoms indicative of a disposition to curvature, which merits attention. Mr. Lloyd is in direct opposition to the principles broached, in this Journal, by Dr. E. Harrison. He supports the doctrine ?f Pott respecting the nature of spinal diseases, and avers, that dissection, which is, after all, the great test in these cases, shows the reality of the caries and absorption of the vertebrae in angular curvatures. The condition of the invertebral substance,_ or each layer, as they are termed, is extremely uncertain.
Many interesting examples, in support of these facts, are reported by our indefatigable author. Thus far we have followed Mr. Lloyd as a surgeon of no common talents, and one who seems to have profitted of the many favourable opportunities he has enjoyed, for the promotion ot one of the most interesting branches of surgical investigation.
When, however, he enters on the province of the physician,and undertakes to treat of scrofulous diseases of the viscera, all of which he debates in the course of twenty-eight Pagcs only, we are inclined to exclaim, Ne silt or ultra crepulavi. We have no 416 ' Critical Analysis. hesitation in saying, that the physician will find nothing in this part of the work, by which he can improve his present knowledge of the diseased condition of visceral organs, labouring under the baneful influence of what has been termed a scrofulous diathesis. The few facts which Mr. Lloyd has added to our stock of morbid appearances in these cases, will not contribute, we apprehend, to throw any better light on the intricate question they are brought forward to illustrate.
The book concludes with a section on " scrofulous ophthalmia;" and a curious account of the ophthalmia so long prevalent in Christ's Hospital.
We shall not sum up, after detailing so much at length the evidence by which our readers are to judge of Mr. Lloyd's book; but will leave them to decide on the extent of its merits, unbiassed by any observation of our own. The opening of the new scholastic year for the students in medicine, has induced us to take an early notice of the present work. To those who are about to acquire the first rudiments of anatomy, Mr. Shaw's book will prove a valuable present. It will be a clear and sure guide to them; it will serve to smooth the path through the various difficulties, and often intricate, researches of anthropography; it will assist their memory in the storing-up of newly-lenrned facts ; and, lastly, it will be found a very useful syllabus, and one of the best text-books for an anatomical class.
Of such a book, of course, it is unnecessary to give a minute analysis ; but that which we cannot omit to give, is an account of the manner in which the work has been composed. By doing this, we shall, doubtlessly, excite a desire in the junior branch of the profession to possess the book; an object, in the accomplishment of which a reviewer should centre all his efforts; since it is thus that the best interests of science are promoted, when a work of merit is the subject of critical consideration.
In an Introduction, of six pages, the young student is put in possession of some general rules upon his entering on a course of dissections. Here the author inculcates the necessity of attending to the real end of anatomy, which does not consist in teaching minutely, but philosophically and practically, the organization of those parts, the recollection of which would be of Mr. Shaw's Manual for the Student of Anatomy. 417 Use when the student is left to his own resources. With respect to the instruments required by young dissectors, Mr. Shaw has the following observations: 4is Critical Analysis. illustrate. We cannot help observing, that, in speaking of his predecessors or contemporaries, Mr. Shaw has assumed a sort of dictatorial tone, which, we humbly submit, ill becomes a young teacher, and one whose name has not yet travelled far; though we venture to predict that it will do so, at no very distant period. Mr. Shaw is also, we think, too fond of insinuations, where he does not consider it safe to be explicit. In the Introduction, there are two or three instances of such insinuations, evidently directed against some teachers and dissectors, which savour strongly of bad taste, to say the least of them.
Mr. Shaw should also learn to be more frugal in his commendation of the teacher whose assistant and relation he is known to be, and whose lauds, when chaunted so frequently by ao interested party, may, in the eye of the malicious, appear to be dictated by partiality. On another point we beg to make only one observation. We are decidedly of opinion that the quaintness of style and affected construction of language, which Mr. Shaw lias adopted, in evident imitation of the same master, will prove injurious to his future reputation-However well such a style and such a language may be thought, by that gentleman and Mr. Shaw, to suit the purpose of oral delivery, there is no doubt but that it ill becomes the dignity, as well as the simplicity, of written composition. It was well said, by the .Edinburgh reviewer, on a recent occasion, when remarking on the numerous fustian-writers of the present day, that, if they will not condcscend to the unstudied and familiar mode of communing with the public, they should, at least, have the art of concealing their art, and not obtrude the conviction that the}' are more anxious to display themselves than to inform their readers.
Mr. Shaw knows so well how highly we think of his talents, and how great are our expectations of his future professional exertions,?and we are so full}7 convinced that he has no need of meretricious adjuvants to take and maintain his proper and enviable station amongst us,?that we have been the less scrupulous in giving him, on the present occasion, a well-meant piece of advice.
We now proceed onwards with our account of his excellent work.
The parietes of the abdomen having been removed, the viscera of that cavity offer themselves to view. The observations respecting them are full of practical utility. Mr. Shaw treats afterwards of the dissection of the diaphragm and deep muscles of the abdomen ; and gives the proper method of examining the minute btructure of the several viscera, as well as of injecting and dissecting the arteries and veins of those viscera.